Provider Demographics
NPI:1811388432
Name:WAYNE FLEISHHACKER, DO, LLC
Entity Type:Organization
Organization Name:WAYNE FLEISHHACKER, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISHHACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-291-8442
Mailing Address - Street 1:135 KINNELON RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2333
Mailing Address - Country:US
Mailing Address - Phone:973-291-8441
Mailing Address - Fax:
Practice Address - Street 1:135 KINNELON RD
Practice Address - Street 2:SUITE 206
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2333
Practice Address - Country:US
Practice Address - Phone:973-291-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty